palm beach state college lunch and learn lecture series september 18, 2012 dudley brown, jr., md,...
TRANSCRIPT
ROUTINE HEALTH SCREENINGS: WHAT YOU SHOULD KNOW (A
GYNECOLOGIST’S PERSPECTIVE)
Palm Beach State College Lunch and Learn Lecture Series
September 18, 2012
Dudley Brown, Jr., MD, MBA
Background: BS in Psychology--University of Miami (Coral Gables) MD--University of Florida College of Medicine Residency in Obstetrics and Gynecology--Cook County
Hospital, Chicago, IL (Chief Resident) Private Practice in Woodstock, IL for 8 yrs (Medical
Director) MBA--Northern Illinois University
Office locations: Forest Hill & N. Flagler Dr (by Good Samaritan Hospital) in WPB; University Dr in Jupiter
Surgeries and Deliveries at Good Samaritan and St Mary’s Medical Centers in WPB
(561)357-6277 www.tenetfloridaphysicianservices.com
Routine Health Screenings: Cancer Screening
Cervix Breast Ovary Colorectal Prostate
Cervix: Worldwide
2nd most common cancer in women ~500,000 new cases/ year ~275,000 deaths / year
Cervix: Impact in the US
>70% decline in mortality last 60 years #13 in cancer deaths for women In 2010, ~12,200 new cases and ~4,200 deaths
Cancer screening: Cervix
50% of new cases are in unscreened women 10% had not had a screen in 5 years 30% due to system error (sampling,
interpretation)
Cervix: Current Pap Smear Recommendations
Under 21 y/o, do not screen 21-29 y/o, Pap every 2 yrs 30 y/o and older, Pap every 3 yrs if 3
consecutive negative tests 65 y/o and older, stop if 3 consecutive negative
tests & no abnormal tests in last 10yrs Any age after hysterectomy, stop if done for
benign condition (e.g. fibroids, abnormal periods) and no h/o HG CIN
Cancer Screening: Breast (US Impact)
Most common cancer in women #2 in cancer deaths in women 37% decline in mortality from 1997 to 2005 2010 estimates; ~207,000 new cases, ~40,000
deaths
Breast: Current Screening recommendations
Ages 40-49, every 1-2 yrs (varies by organization)
Ages 50-74, every 1-2 yrs (varies by organization)
Age 75 and older, No recommendation for age to stop
ACOG recommends clinical breast exam annually after 19 y/o
“Self breast awareness” recommended
Cancer Screening: Ovary (US Impact)
2nd most common Gyn Cancer #1 in Gyn cancer deaths 2010 estimates; ~21,800 new cases, ~13,800
deaths
Cancer Screening: Ovary
~75% diagnosed at > stage 2 Nonspecific symptoms No proven screening test Recommended screening test is an annual
pelvic exam CA 125 is not a recommended screening test
Ovary: CA 125 Liabilities
High false positive rate leading to unnecessary surgery and increased cost
Identifies late stage disease Research continues for an effective screening
test
Cancer Screening: Colorectal
#3 in cancer deaths in women & men (#2 for Hispanic men)
50% screening rate in US Average risk people should begin screening at
50 y/o Screening tests include; FOBT, Stool DNA test,
Flexible Sigmoidoscopy, Colonoscopy
Cancer Screening: Prostate
Most common cancer in men Walnut-sized organ just below bladder and in
front of rectum 200,000 men diagnosed annually and 25,000
deaths Risks factors: age > 50, African American, 1st
degree relative with disease
Cancer Screening: Prostate
Difficulty in starting urination Weak or interrupted flow of urine Frequent urination, especially at night Difficulty in emptying the bladder
completely Pain or burning during urination Blood in the urine or semen Pain in the back, hips, or pelvis that doesn't
go away Painful ejaculation
Some men do not have any symptoms
Cancer Screening: Prostate Controversy exits regarding screening
recommendations USPSTF recommends against PSA-based
screening in men without symptoms Usual screening tests: Digital Rectal Exam (DRE)
and Prostate Specific Antigen (PSA)
Routine Health Screening: Benign Conditions
Thyroid Diabetes Cholesterol Bone Density
Routine Health Screening: Thyroid
Recommendations vary per organization Start at 35 y/o and screen every 5 yrs with TSH
blood test (American Thyroid Association) Screen at 50 y/o (American College of
Physicians) Other organizations say only screen if someone
in symptomatic Bottom line, discuss with your physician,
especially if there is a family history of Thyroid disease
Routine Health Screening: Diabetes
Screen with blood test if BMI >25 and another risk factor present (e.g. Hypertension, age > 45, certain ethnic groups, habitual physical inactivity) American Diabetes Association
Screen if BP consistently > 153/80 (treated or untreated) USPSTF
Screen in pregnancy Bottom line, discuss with your physician,
especially if there is a family history of Diabetes
Routine Health Screening: Osteoporosis
Osteoporosis is characterized by low bone mass (density) and architectural changes in the bone which increases the susceptibility to fracture
Routine Health Screening: Bone Density
Postmenopausal women age 65 and older Postmenopausal women younger than age 65 if
risk factors are present (e.g. previous fracture as an adult, parents with h/o hip fracture, steroid therapy, low body weight, smoking)
No screening for premenopausal women
Routine Health Screening: Cholesterol
Start screening with a blood test at age 20 and every 5 yrs after that, NCEP III
Start at age 20 for men or women risk factors for CHD, USPSTF
Start at age 35 for men and age 45 for women if no risk factors for CHD, USPSTF
Bottom line, speak with your doctor
Summary: Prevention and Routine Screening
Lung (#2) Colorectal (#3) Diabetes Cholesterol
Lifestyle changes (proper diet, regular exercise, no smoking, alcohol in moderation)
Questions?
Dr. Dudley Brown, Jr. Board Certified, Ob/ Gyn Offices in West Palm Beach and Jupiter (561)357-6277 Accepting New Patients